Choice and Consequences in the Medicare Part D Plan

描述(由申请人提供)：2003年的《联邦医疗保险现代化法案》，更为人所知的是将D部分处方药福利添加到联邦医疗保险计划中的立法，代表着过去40年来美国公共保险计划最重大的一次扩张。这项立法最新颖和最有争议的特点可能是使用多个私营保险提供商提供这种新的公共保险产品，其价格和产品功能差异很大(包括甜甜圈洞，即个人可以为初始药物支出提供保险，但不包括较高水平的支出)。我将使用一个独特的数据集来评估D部分的效果，该数据集允许我在2005至2009年间跟踪数百万老年人，包括他们的处方药覆盖范围和他们对D部分计划的选择。特别是，这个项目旨在回答六个问题。首先，老年人在选择他们的D部分计划时面临什么财务风险；在他们的国家选择替代计划的财务后果是什么？其次，老年人是否选择了将处方药保险总成本降至最低的D部分计划，如果没有，他们通过选择留下了多少钱？第三，是什么决定了D部分计划的选择？我将估计一个全面的计量经济学计划选择模型，以评估金融和非金融因素在推动选择中的作用。第四，是什么决定了计划选择的动力？如果个人选择了一个不合适的计划，他们会重新优化吗？还是计划选择有很强的惯性？第五，D部分计划的结构如何影响使用率？这些纵向数据，以及计划选择中惯性提供的潜在计量经济学识别，将使我能够对利用弹性进行估计。最后，处方药的使用如何应对年内费用分摊方面的变化？了解个人是否预料到甜甜圈空洞，以及他们如何对这一特征做出反应，对于模拟D部分福利结构的改革至关重要。这些分析的结果将是关于D部分的选择是如何做出的，以及这些选择如何影响受益药物利用的第一个全面图景。这些发现应该对政策制定者非常有帮助，因为他们正在考虑正在进行的这一重大福利计划的改革。 2003年的《联邦医疗保险现代化法案》，更广为人知的名称是将D部分处方药福利添加到联邦医疗保险计划中，这是过去40年来美国公共保险计划最重大的一次扩张。这项立法最新颖和最有争议的特点可能是使用多个私营保险提供商提供这种新的公共保险产品，其价格和产品功能差异很大(包括甜甜圈洞，即个人可以为初始药物支出提供保险，但不包括较高水平的支出)。我将首先全面介绍D部分的选择是如何做出的，以及这些选择如何影响受益药物的使用。这些发现应该对政策制定者非常有帮助，因为他们正在考虑正在进行的这一重大福利计划的改革。

DESCRIPTION (provided by applicant): The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will evaluate the effects of Part D using a unique data set that allows me to follow several million elders over the 2005 to 2009 period, with data on both their prescription drug coverage and their choice of Part D plan. In particular, this project aims to answer six questions. First, what is the financial risk facing elder when choosing their Part D plans; what are the financial consequences of alternative plan choices in their county? Second, are elders choosing the part D plan that minimizes their total cost of prescription drug coverage, and, if not, how much money are they leaving on the table through their choices? Third, what determines choice of Part D plan? I will estimate a comprehensive econometric model of plan choice to assess the role of financial and non-financial factors in driving choices. Fourth, what determines the dynamics of plan choice; do individuals re-optimize if they have chosen an inappropriate plan or is there very strong inertia in plan choice? Fifth, how does the structure of Part D plans affect utilization? These longitudinal data, and the potential econometric identification that is provided by inertia in plan choice, will allow me to develop estimates of utilization elasticity. Finally, how does prescription drug use respond to within-year changes in cost-sharing? Understanding whether individuals anticipate the donut hole, and how they react to this feature, is critical for modeling reforms to the Part D benefit structure. The result of these analyses will be the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy- makers as they consider ongoing reforms of this major entitlement program. The Medicare Modernization Act of 2003, better known as the legislation that added the Part D prescription drug benefit to the Medicare program, represents the single most significant expansion of public insurance programs in the U.S. in the past 40 years. Perhaps the most novel, and controversial, feature of this legislation was the use of multiple private insurance providers to deliver this new public insurance product, with widely varying prices and product features (including the donut hole whereby individuals are covered for initial drug expenditures but not for higher levels of expenditures). I will provide the first comprehensive picture of how Part D choices are made, and how those choices impact beneficiary drug utilization. These findings should be very helpful to policy-makers as they consider ongoing reforms of this major entitlement program.